FAQ – Off Exchange

FAQ – Off Exchange

Open Enrollment

Open Enrollment is the yearly period when people can enroll in a health insurance plan.

Your policy will automatically renew each year as long as you continue to make your premium payments. If you would like to make changes to your policy, you must contact the Health Insurance Marketplace via Healthcare.gov or by calling 1.800.318.2596 to make those changes.

Special Enrollment refers to a time period outside the annual open enrollment time frame. You could qualify for Special Enrollment if you recently had an altering life event, and you would like to enroll or change a plan based on that event.

You may qualify for Special Enrollment if you or anyone in your household in the past 60 days had the following: changes in household, changes in residence or loss of health insurance.

Click here for more details.

Policy & Enrollment Questions

You may be asked to submit documents to verify or add to information to your application such as your income, citizenship or immigration status. If you don’t submit the documents by the date included in the notice, you could lose your health insurance or savings. You can upload documents online, which is the fastest and easiest way to get them processed. Or you can mail copies instead.

Upon applying for healthcare coverage, your information will be evaluated to determine if you qualify for an Advance Premium Tax Credit (APTC). Qualifying individuals are eligible to receive a deduction from their monthly premium payments as long as supporting documents and tax information is provided. Qualifying factors may include family size and household income.

If you do not want your current policy to automatically renew, please contact the Health Insurance Marketplace. You may either contact them via phone at 1.800.318.2596 or through their website at Healthcare.gov.

Yes, you are allowed to make multiple elections during the Open Enrollment period. Please contact the Health Insurance Marketplace at 1.800.318.2596 for more information.

Yes, you have the option of enrolling directly with Community instead of applying through the Health Insurance Marketplace. Please contact one of our business development representatives at 713.295.6760. They will help you with the enrollment process.

Please contact the Health Insurance Marketplace to verify if you qualify for Special Enrollment.

If you have made any changes to your policy information, please allow 5-7 business days from the date you contacted the Health Insurance Marketplace for our systems to update. If you still do not see the correct policy within the given time period, please contact us by logging into your My Member Account.

As a Member, you have the right to terminate coverage for yourself and any enrolled dependents. If you wish to terminate coverage for any reason, please complete and submit the Policy Termination Form to Community Health Choice. This form can be returned via e-mail to: [email protected], by fax to (713) 295-2296- Attn: Fulfillment Department or by mail to Community Health Choice, Attn: Fulfillment Dept., 2636 South Loop West., Suite 125, Houston, TX 77054.

Premium Questions

Per the Health Insurance Marketplace, available plans change and prices increase every year. You do have the option of choosing a plan that allows you to keep a low monthly premium payment.

Your premium is due before the first of each month. After that, it is considered late. This payment is for the upcoming month of coverage.

For example, a payment that you make on February 28 is for March coverage.

Members are able to make their premium payment using one of the following options:

  1. Go to the Community Health Choice website and login to your My Member Account or create an account.
  2. Make a quick payment without creating an account.
  3. Mail money order or check to:
    Bank of America Lockbox
    P.O. Box 844124
    Dallas, TX 75284-4124
  1. Here is a list of available locations where you can pay your premium.

Your invoice is mailed to you once a month. You may also access your invoice via your My Member Account.

Monthly premium payments are due by the last day of the month prior to the start of the next month’s coverage.

If you have APTC, you have a grace period of 90 days to bring your account up to date. If you do not have APTC, you have 30 days to bring your account up to date. If you are unsure whether you have APTC, please call Member Services at 713.295.6704 or toll-free at 1.855.315.5386.

The invoices are mailed out monthly at the beginning of the month before the start of a new the next month. For example, your January invoice will be mailed out in December.

You will need to submit proof of using your bank statements either by fax or by uploading it via the My Member Portal.

You can leave the payment as a credit for the next billing cycle or if you have not been billed for the next billing cycle, you may receive a refund.

Your health plan coverage becomes official when we receive your first payment, which takes care of your first month of coverage. You only have 30 days from the day you enroll to make your first payment and for it to post to your account.

To set up recurring payments, you must create or login to your My Member Account and follow the steps below.

Once you are logged in:

  1. Click on “Make a Payment”
  2. Click on “Manage Recurring Payments”
  3. Click on “Add new Automatic Payment “
  4. Fill in the information and select date, then click “Next”
  5. Confirm and Submit
  1. Your monthly premium includes the original premium for your plan minus any tax credits (APTC) or incentives you qualify for.
  2. Your current charges include your monthly premium plus or minus any adjustments to your account.
  3. Your forwarded balance includes any previous unpaid balance.
  4. Your total amount due includes your current charges plus your forwarded balance, if there is one.

If you do not delete your recurring payments, they will roll over. We encourage you to make any edits to your recurring payments as needed during your new enrollment.

The payment method will affect how long it will take to process your payment. If you have made your payment by sending a check, it may take up to 10 business days for the payment to post. If you have made a payment with a credit/debit card, your payment may take 3-5 business days to process and be posted to your account.

We strongly recommend you make a payment only once. but multiple payments are acceptable. Please be advised that the full payment must be made before the start of the new month to avoid being in delinquent status.

We recommend that when setting up your recurring payments, your settings are set to Total Amount Due. Then the correct amount will be drafted, even if your policy changes throughout the year. To set up auto payments, please visit your My Member Account.

A Guide to Insurance Terms

An amount to be paid for an insurance policy.

A fixed fee that you pay for healthcare services and products (such as doctor visits and pharmaceutical prescriptions).

The amount you must pay for healthcare expenses before insurance covers the costs. Sometimes, a health insurance plan will have a yearly deductible that you must meet before coverage begins.

The amount you must pay for healthcare expenses after your deductible has been met. Coinsurance amounts are shared amounts between the health insurance carrier and you. Your portion of the coinsurance is paid until your out-of-pocket maximum is met for the year. Example: Joe has insurance that pays 80% of medical expenses. Joe has a doctor visit. The visit cost is $100. Joe pays $20 (coinsurance amount), and his insurance pays $80.

This is the maximum amount you will pay out of your own pocket in a year for covered health care expenses. Typically, after your out-of-pocket maximum expense limit is met, the plan pays 100% of all covered services for the remainder of the year.

A specified period of time when you can enroll in an insurance plan.

A Provider who is contracted with the health plan to provide services to plan Members for specific, pre-negotiated rates.

A Provider who is not contracted with the health plan.

A healthcare condition that existed before insurance coverage begins.

A healthcare professional (usually a physician) who is responsible for monitoring your overall healthcare needs.

A healthcare professional who specializes in one area of medicine. For example, a cardiologist is a doctor who specializes in heart conditions.

Why Choose Community?

As a local nonprofit health plan, Community Health Choice gives you plenty of reasons to join our Community. From the benefits and special programs we offer to the way our Member Services team helps you make the most of them, Community is always working life forward for you and your family.

“I always tell people to choose Community Health Choice. I tell them it’s the best health insurance they will ever be with.”

– Chandolyn
Member of Community Health Choice